II. Definitions:
- Pediatric Isotonic Dehydration
- Serum Sodium: 130 - 150
III. Protocol: Example Case
- Weight: 35 kg Child
- Dehydration: 10%
- Serum Sodium: 140 (Normal)
IV. Protocol: Stabilization with Bolus Fluids (Phase I)
- See Pediatric Dehydration Management
- Give 20 ml/kg Normal Saline or Lactated Ringers over 10-15 minutes
- May repeat bolus until circulation stable
- May require up to 60 ml/kg within the first 1-2 hours
V. Protocol: Calculate Maintenance Fluid Requirements
- Approach as per Pediatric Dehydration Management
- See Maintenance Fluid Requirements in Children
- Hourly = 75 cc/hour for 35 kg child
- First 10 kg: (4 cc/kg/hour x 10 kg)
- Next 10 kg: (2 cc/kg/hour x 10 kg)
- Remaining 15 kg: (1 cc/kg/hour x 15 kg)
- Daily: 1800 cc/day
VI. Protocol: Calculate Remaining Deficit to be Replaced
- See Pediatric Dehydration Management
- Estimate level of Dehydration
- Mild Dehydration (3%) = 30 ml/kg
- Severe Dehydration (12%) = 120 ml/kg
- Subtract Phase 1 Resuscitation already replaced
- Calculation
- Phase 1: 20 ml/kg/bolus x 35 kg x 1 bolus = 700 ml
- Deficit (10%): 100 ml/kg x 35 kg = 3500 ml
- Remaining Deficit: 3500 ml - 700 ml = 2800 ml
VII. Protocol: Divide 2800 cc Remaining Deficit over 24 hours
- First 8 hours: 75 ml/h + 1400 ml/8h = 250 ml/hour
- Next 16 hours: 75 ml/h + 1400 ml/16h = 163 ml/hour
VIII. Protocol: Saline guide (Rough)
- Precautions
- Exercise caution with hypotonic solutions (Hyponatremia)
- Consider D5 NS as maintenance fluid instead of D5 1/2NS
- McNab (2015) Lancet [PubMed]
- Weight <28 kg: D5 1/2NS (prior recommendation D5 1/4NS)
- Weight >28 kg: D5 NS
IX. Protocol: Summary - 35 kg Child with isotonic Dehydration
- Initial Bolus: 700 ml (20 ml/kg)
- First 8 hours: D5 NS with 20 KCl at 250 ml/hour
- Next 16 hours: D5 NS with 20 KCl at 163 ml/hour
X. Resources
- Vega and Bhimji (2017) Pediatric Dehydration in Stat Pearls
XI. References
- Walton (2020) Crit Dec Emerg Med 34(6): 3-9
- Canavan (2009) Am Fam Physician 80(7):692-6 [PubMed]